Provider Demographics
NPI:1184751539
Name:DECKER, GIGI J (NCTMB, BA)
Entity type:Individual
Prefix:MRS
First Name:GIGI
Middle Name:J
Last Name:DECKER
Suffix:
Gender:F
Credentials:NCTMB, BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2208 EDGEBROOK AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55119-5059
Mailing Address - Country:US
Mailing Address - Phone:651-983-6954
Mailing Address - Fax:651-999-6995
Practice Address - Street 1:6025 LAKE ROAD
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125
Practice Address - Country:US
Practice Address - Phone:651-983-6954
Practice Address - Fax:651-999-6995
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
001818-00OtherNCTMB